Adverse Childhood Experiences and Adult Well-Being: Main Effects and Mediators

Background: While previous studies of Adverse Childhood Experiences (ACEs) have emphasized physical and mental health outcomes, impacts on educational and occupational attainment as well as crime are not known, especially for economically disadvantaged populations. Further, the processes through which ACEs affect outcomes are not clear. This study tests (1) the association between ACEs during childhood and multi-dimensional well-being in early adulthood for a low-income urban cohort, (2) whether a preschool preventive intervention moderates this association, and (3) potential mechanisms for ACE effects on well-being

Methods: Follow-up data were analyzed for 1,202 low-income, minority participants in the Chicago Longitudinal Study, a prospective investigation of the impact of early experiences on life-course well-being. Born in 1979-1980 in high-poverty neighborhoods, individuals retrospectively reported ACEs from birth to adolescence, except in cases of child abuse and neglect. Nine measures of well-being were assessed by administrative records and self-reports between ages 18 and 26, including educational attainment, occupational status, crime, depressive symptoms, and health compromising behavior.

Results:  Nearly two-thirds of the study sample experienced one or more ACEs by age 18. After controlling for demographic factors and early intervention status, individuals reporting ACEs were significantly more likely to exhibit poor outcomes than those with no ACEs. Those with four or more ACEs had significantly reduced likelihood of high school graduation (OR = .37; p < .001) and completion (OR = .50; p < .001), increased risk for depression (OR = 3.9; p < .001), health compromising behaviors (OR = 4.5; p < .001), juvenile arrest (OR = 3.1; p < .001) and felony charges (OR = 2.8; p < .001). They were also less likely to hold skilled jobs (OR = .50; p = .001) and to go further in school even for adversity measured by age 5. Although adverse outcomes generally increased as a function of increasing ACEs, thresholds were also evident. Preschool intervention did not moderate the association between early ACEs and well-being.

Conclusions: ACEs consistently predicted a diverse set of adult outcomes in a high-risk economically disadvantaged sample. Cognitive advantage, family support, school support, and social adjustment measures accounted for between 15% and 30% of the ACEs-to-adult-outcomes relationships. Effective and widely available preventive interventions are needed to counteract the long-term consequences of ACEs.